CMS Formulary

Displaying 127401-127410 of 1611142 results.
ID: 127401
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 197363
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 127402
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 197364
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 127403
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 197383
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 127404
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 197382
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 127405
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 805515
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 380
Qty Limit Days: 30
ID: 127406
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 603378
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 127407
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1190225
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 20
ID: 127408
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 580261
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 127409
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 836368
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 127410
Formulary ID: 00021052
Formulary Version: 17
Contract Year: 2021
RXCUI: 1552004
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 30